Provider Demographics
NPI:1720445091
Name:BARTZ, PATRICIA VICTORIA (MSOTR/L)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:VICTORIA
Last Name:BARTZ
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1632
Mailing Address - Country:US
Mailing Address - Phone:408-410-0750
Mailing Address - Fax:
Practice Address - Street 1:361 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1632
Practice Address - Country:US
Practice Address - Phone:408-410-0750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5851225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist